What is alcohol withdrawal?
By Dr Vasilios Silivistris
Alcohol withdrawal differs from withdrawal from most other drugs because it can be fatal. The only drugs as likely to cause death from withdrawal are benzodiazepines. Heroin withdrawal rarely, if ever, results in death.
However, untreated major alcohol withdrawal can be fatal in one in three cases. Fortunately, these deaths are almost entirely preventable when individuals are properly tapered off alcohol.
Three levels of alcohol withdrawal
Level 1 Minor Withdrawal: Shaky hands, Sweating, Mild anxiety, Insomnia, Nausea, Headache.
These symptoms may appear within 6 to 12 hours after stopping drinking.
Level 2 Mid-level Withdrawal: More intense minor symptoms, with visual, auditory, or tangible hallucinations. The individual is usually aware that the hallucinations are not real.
Possible seizures, Racing pulse, Irregular heartbeat.
These symptoms can emerge within 12 to 48 hours after cessation of use.
Level 3 Major Withdrawal: Delirium, Alcohol-induced hallucinations, Profuse sweating, Seizures, Severe blood pressure spikes, Severe tremors, Racing and irregular heartbeat, Fever.
Potentially fatal, these symptoms may develop within 48 to 72 hours of stopping and peak around five days. Major withdrawal is the most dangerous.
In popular US slang, the shakiness seen in mild alcohol withdrawal is often called delirium tremens. This use of terminology can be confusing because, technically, delirium tremens is associated with major withdrawal. Genuine delirium tremens is life-threatening, killing about one in three untreated cases. However, the shakiness in minor withdrawal is not life-threatening.
What causes alcohol withdrawal?
Alcohol withdrawal results from neurotransmitter rebound.
When alcohol suppresses a neurotransmitter system over an extended period, the system adapts by working harder to compensate and maintain normal function despite the presence of alcohol.
When alcohol is suddenly removed, the neurotransmitter system continues to operate in overdrive.
Since alcohol is no longer present to suppress these effects, the system’s hyperactivity causes effects opposite to those of alcohol. It’s akin to two people playing tug-of-war, balanced evenly; if one suddenly lets go, the other is thrown in the opposite direction.
Removing alcohol from a neurotransmitter system fighting to overcome its effects causes the system to shoot off in the opposite direction.
The primary neurotransmitter involved in alcohol withdrawal is the GABA system. GABA receptors respond to gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the mature vertebrate central nervous system.
Alcohol’s impact on the GABA system results in Relaxation, Sleep, Calmness, A relaxed feeling, Reduced panic.
When alcohol is abruptly removed, neurotransmitter rebound in the GABA system leads to: Insomnia, Nightmares, Hallucinations, Anxiety, Panic, Muscle cramps, Seizures.
Benzodiazepines affect the GABA system similarly, which is why benzodiazepine withdrawal can also be life-threatening.
Dr Vasilios Silivistris (Vasos) is a psychotherapist, counselling practitioner psychotherapycounselling.uk